Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke: A Matched-Pairs Analysis
| Autor: | Marcel Arnold, Monika Bühlmann, Gerhard Schroth, Frauke Pult, Urs Fischer, Simon Jung, Corrado Bernasconi, Jan Gralla, Heinrich Mattle, Anne Broeg-Morvay, Pasquale Mordasini |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Tissue plasminogen activator law.invention Brain Ischemia Brain ischemia 03 medical and health sciences 0302 clinical medicine Mechanical Thrombolysis Randomized controlled trial Fibrinolytic Agents Modified Rankin Scale law Internal medicine medicine Humans Thrombolytic Therapy 610 Medicine & health Aged Retrospective Studies Thrombectomy Advanced and Specialized Nursing Aged 80 and over business.industry Thrombolysis Middle Aged medicine.disease Surgery Stroke Treatment Outcome Tissue Plasminogen Activator Cardiology Administration Intravenous Female Neurology (clinical) Cardiology and Cardiovascular Medicine business Plasminogen activator 030217 neurology & neurosurgery Fibrinolytic agent medicine.drug |
| DOI: | 10.7892/boris.81246 |
| Popis: | Background and Purpose— Five randomized controlled trials have consistently shown that mechanical thrombectomy (MT) in addition to best medical treatment (±intravenous tissue-type plasminogen activator) improves outcome after acute ischemic stroke in patients with large artery anterior circulation stroke. Whether direct MT is equally effective as combined intravenous thrombolysis with MT (ie, bridging thrombolysis) remains unclear. Methods— We retrospectively compared clinical and radiological outcomes in 167 bridging patients with 255 patients receiving direct MT because of large artery anterior circulation stroke. We matched all patients from the direct MT group who would have qualified for intravenous tissue-type plasminogen activator with controls from the bridging group, using multivariate and propensity score analyses. Functional independence was defined as modified Rankin Scale score of 0 to 2. Results— From February 2009 to August 2014, 40 patients from the direct MT group would have qualified for bridging thrombolysis but were treated with MT only. Clinical and radiological characteristics did not differ from the bridging cohort, except for higher rates of hypercholesterolemia ( P =0.019), coronary heart disease ( P =0.039), and shorter intervals from symptom onset to endovascular intervention ( P =0.01) in the direct MT group. Functional independence, mortality, and intracerebral hemorrhage rates did not differ ( P >0.1). After multivariate matching analysis outcome in both groups did not differ, except for lower rates of asymptomatic intracerebral hemorrhage ( P =0.023) and lower mortality ( P =0.007) in the direct MT group. Conclusions— In patients with large anterior circulation stroke, direct mechanical intervention seems to be equally effective as bridging thrombolysis. A randomized trial comparing direct MT with bridging therapy is warranted. |
| Databáze: | OpenAIRE |
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